Sunday, 10 June 2012

Care for elderly 'let down by fragmented system'


Care for elderly 'let down by fragmented system'

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By Jane DreaperHealth correspondent, BBC News
Old person's handsMPs want a single body for social care

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Older people are being let down by a social care system in which they are "passed like a parcel" between services, a committee of MPs has said.
The Commons health select committee wants local areas in England to deliver "joined-up" care, health and housing.
Funding pressures were reducing older people's quality of life, MPs added.
The government said "urgent reform of the care and support system is needed", and that it was creating the conditions for more integration.
The committee's report said that the Health and Social Care Bill - currently making its way through Parliament - would not simplify a fragmented system in England.
Rather than the current system of multiple funding sources, the MPs are calling for a single local body with the power to commission health, support services and housing.
The precise model would depend on local circumstances, they suggest.
The committee says in its report: "Despite repeated attempts to 'bridge' the gap between the NHS and social care... little by way of integration has been achieved over a 40-year period.
"These separate systems are inefficient and lead to poorer outcomes for older people."
Funding gap denied
Evidence was cited in the report that services which worked together to help keep older people well could potentially save the NHS £2.65 for every £1 spent by, for example, avoiding emergency admissions to hospital.

“Start Quote

Growing demand makes it more urgent than ever before to convert fine words into fine deeds”
Stephen Dorrell MPHealth committee chairman
The committee visited projects which had successfully integrated care in Torbay, Devon, and Blackburn, Lancashire.
However, the report points out that the care trusts that had pioneered integration in these areas are due to lose their commissioning functions under the controversial Health and Social Care Bill.
The MPs acknowledged that the government was putting extra money into social care in England - but said they had still received a "weight of evidence" which pointed to funding pressures and service cuts.
The government's commitment of an extra £2bn a year for social care by 2014/15 was "not sufficient to maintain adequate levels of service quality and efficiency", the report claimed.
In a hearing with the committee, Health Minister Paul Burstow denied there was any gap in social care funding.
'Efficiency challenge'
The Conservative MP and former Health Secretary, Stephen Dorrell, who chairs the committee, said: "This government, like its predecessors going back to the 1960s, has stressed the importance it attaches to joined-up services.
"Growing demand, coupled with an unprecedented efficiency challenge, makes it more urgent than ever before to convert these fine words into fine deeds.
"It is impossible to deliver high quality or efficient services when the patient is passed like a parcel from one part of the system to another.
"We recommend that the government should place a duty on the new clinical commissioning groups and local councils to create a single commissioning process for older people's services."
Ministers in England are due to publish a White Paper on social care in the coming months.
The committee is calling on the government to implement the findings of the independent Dilnot Commission, which last year recommended a system in which the costs of care for individuals were capped.
MPs warned though that the future of social care should not be "dominated by a debate about the technical details of funding".
They said carers needed more support - but this was too often not identified by staff such as GPs and social workers.
'Disastrous'
The King's Fund think tank estimates that 890,000 people are not receiving the care services they need - a figure which is disputed by ministers.
A senior fellow at the King's Fund, Richard Humphries, said: "Delivering integrated care must assume the same priority over the next decade as reducing waiting times was given over the last.
"The committee is right to stress that a more ambitious approach is needed to achieve this based on co-ordinated commissioning and pooled budgets.
"We think this could go a stage further by moving towards a single assessment of the funding needs of the NHS and social care in future spending reviews."
The shadow care minister, Liz Kendall, said: "Far from focusing on what older people and their families really need, the government has instead wasted 18 months on its disastrous NHS reorganisation.
"As the committee points out, some of the best examples of integrated care have been achieved by Care Trusts, which will be swept away by the government's own Health and Social Care Bill."
Mr Burstow said: "Integrated care should be the norm. That's why we asked the NHS Future Forum to specifically work on this issue. They told us there is no single silver bullet when it comes to integration.
"What we have already done and continue to do is create the legal and financial conditions for more integration."
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Wednesday, 30 May 2012

Social care funding gap


Social care funding gap in England 'can be plugged'



Elderly manThe funding gap for reforming social care in England could be plugged by raiding the NHS surplus or restricting access to benefits such as the winter fuel allowance, experts say.
A review published last year suggested care costs should be capped, but this would cost an extra £1.7bn a year.
The Nuffield Trust analysis believes this sum could be found from within existing public sector spending.
The think-tank said tax rises could be used too.
But it questioned whether that would be appropriate in the current financial climate and said if they were to be introduced they should be targeted at elderly people.
The report comes as the government is still finalising its plans for reforming the way people pay for care in their own homes and in care homes.
A White Paper is expected to be published next month.
Controversy
One of the proposals under consideration is the idea of introducing a cap on lifetime care costs of between £35,000 and £50,000.

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This was put forward by the Dilnot Commission, which was set up by the government to look into the issue.
Funding is the most controversial element of the changes, with the Treasury thought to have concerns about the cost to the public purse of reforming the system.
By 2026, the estimated additional annual cost of £1.7bn is likely to rise to £3.6bn because of the ageing population.
But the Nuffield Trust said it was feasible to look at redistributing current spending to cover the bill.
It pointed out that about £140bn a year is spent on elderly people across the NHS, welfare and social care sectors.
Just 6% of this currently goes on social care.
The Nuffield Trust said the extra cost could be plugged through a variety of measures.
For example, it cited a £1.5bn underspend in the NHS last year.
Money could also be saved by means-testing benefits such as winter fuel payments, travel concessions and free TV licences.
Report author Anita Charlesworth said it was important that the government had an open debate with the public about priorities.
"The government currently spends some £140bn a year on older people.
"If you were starting with a blank sheet of paper is this the best balance of spending to ensure quality of life, dignity and respect in older age?"
Michelle Mitchell, of Age UK, agreed, saying an "honest debate" was needed and she urged ministers to have "courage and conviction" in their attempts to reform the system.
The government said it would be publishing its plans soon.
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Doctors target non-urgent care in industrial action



stethoscope (generic)
The move comes after a majority of doctors voted in favour of action in a British Medical Association ballot of 104,000 members over pension changes.
The 24-hour day of action will take place on 21 June.
The union said emergency care would still take place, as doctors did not want to put patients at risk.
Of those balloted, half responded. Among the main groups of doctors the results were overwhelming.
Some 79% of GPs, 84% of hospital consultants and 92% of junior doctors who responded voted in favour.
By targeting non-urgent care, patients are likely to be affected in this way:
  • Elective operations such as knee and hip replacements likely to be postponed
  • GP practices to remain open, but routine appointments will not take place
  • Hospital appointments for routine conditions expected to be cancelled
  • Tests for critical conditions such as cancer will still be available
  • A&E units and maternity services to run as normal

Analysis

Doctors are among the best-paid public-sector employees - and as such they also have the most lucrative pensions.
The average hospital consultant retiring today will enjoy a pension of £48,000 a year and a lump sum of over £140,000.
Among public-sector pensions being paid out, doctors account for two-thirds of the top 1% of pay outs.
As a result, this government - and the Labour one that preceded it and reformed pensions in 2008 - has taken the judgement that it wants the best-paid to subsidise the pensions of the lowest.
Contributions will rise the greatest for the highest earners. Those earning over £110,000 a year will end up contributing 14.5% of their salary.
Many may understand that approach, but doctors believe they are being unfairly targeted.
They point out that the top-paid civil servants will not be hit in the same way - and that perceived injustice has put the profession at loggerheads with the government.
It will be the first time since 1975 that doctors have taken industrial action.
It is not yet known whether the day of action will be followed by further ones.
Unions representing a host of health professionals, including paramedics, admin staff and porters, have already taken part in strikes over pension changes.
Patient safety 'safeguarded'
But the Royal College of Nursing, one of the most influential voices inside the NHS alongside the BMA, has yet to decide what it will do.
It has held a ballot where the majority rejected the government's pension changes, but the turnout was low.
Under the plans, which apply to England and Wales but could be introduced elsewhere in the UK, the age at which doctors retire would rise from 65 to 68 by 2015.
The contributions doctors have to make are also due to rise.
The union has also questioned government claims that the current scheme - which was only agreed in 2008 - was unsustainable, pointing out it brings in a £2bn-a-year surplus.
BMA leader Dr Hamish Meldrum said while the action would be disruptive, doctors would ensure that patient safety was not compromised.
He added: "We are taking this step very reluctantly and would far prefer to negotiate for a fairer solution.
"But this clear mandate for action - on a very high turnout - reflects just how let down doctors feel by the government's unwillingness to find a fairer approach to the latest pension changes."

But Health Secretary Andrew Lansley said: "The public will not understand or sympathise with the BMA.
"People know that pension reform is needed as people live longer and to be fair in future for everyone."
He said the NHS pension would remain "one of the best available anywhere", pointing out a new doctor joining the revised scheme could still expect a pension of £68,000 a year on retirement.
Dean Royles, director of NHS Employers, added: "We know that doctors are anxious about changes to their pensions. But no-one wants to see patients dragged into the argument.
"Industrial action could potentially mean delays to treatment. It would be particularly distressing for patients and extremely worrying for staff, who are dedicated to putting patients first."
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Friday, 18 May 2012

dementia patient 'had 106 carers'


Aberdeen dementia patient 'had 106 carers'

By Eleanor BradfordBBC Scotland Health Correspondent
    Jeanette Maitland said the constant stream of different faces sent by agencies working for Aberdeen's social work department contravened her husband Ken's basic human right to dignity.
    Jeanette Maitland
    MrJeanette Maitland said the turnover in carers was an affront to her husband's dignity Maitland died from a dementia-related illness last week.
    Aberdeen City Council has pledged to look into the concerns his wife has raised.
    Mrs Maitland told BBC Scotland she initially wrote down the names of her husband's carers so that she could get to know them.
    She added: "I just started taking note of the names so I could remember properly and put a face to the name.
    "Then each time a new face came so I kept writing, writing, writing, until we're here where we are today with 106 carers."Until Mr Maitland's recent admission to hospital he was allocated two carers four times a day to help his wife look after him at home.
    Intensely private
    She was given the impression that care would be provided by a core group of about 10 staff. Instead, she faced a constant stream of new people which her husband found extremely unsettling.
    Mrs Maitland added: "Anyone who knows anything at all about dementia will know that they live in fear 87% of the time. Obviously the more regular the voice, the more regular the regime, the constancy of it all helps them to relax and be calm."
    Although she has no complaints about the overall standard of care, Mrs Maitland said her husband was an intensely private man who would have been horrified at the number of people who were involved in his bathing and personal care.
    She asked: "Where is respect for his dignity? I feel I should have sold tickets."
    Prof June Andrews, director of Stirling University's Dementia Centre, said what happened to Mr Maitland was simply "bad care".Mrs Maitland began keeping a list of new care staff and the list grew longer and longer

    She told BBC Radio's Good Morning Scotland programme: "It is absolutely not acceptable because of the kind of disruption that is caused to people with dementia if they are faced with too many people.    List of names
    "This is something that not only happens at home in people's houses, but also in hospitals.
    "Familiarity helps reduce the symptoms of dementia, and if you are supposed to be looking after someone with dementia then presenting them with a lot of different faces if just bad care."
    Aberdeen City Council chief executive Valerie Watts said: "I would like to extend my sincere condolences to Mrs Maitland and her family following the sad loss of her husband Kenneth.
    "I recently had a very positive meeting with Mrs Maitland where we spoke at length about the care package her husband received from Aberdeen City Council.
    "I gave Mrs Maitland a personal assurance I would look into the concerns she raised and respond at the earliest opportunity."
    She added that council staff worked hard to deliver the best possible care package at all times.
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    Thursday, 10 May 2012

    Most NHS costs wasteful, says Diabetic Medicine


    Diabetes: Most NHS costs wasteful, says Diabetic Medicine

    Diabetes assessmentMore frequent health checks and risk assessments could reduce the cost of diabetes

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    The majority of NHS spending on diabetes is avoidable, says a report in the journal Diabetic Medicine.
    It suggests that 80% of the NHS's £9.8bn annual UK diabetes bill goes on the cost of treating complications.
    Experts say much of this is preventable with health checks and better education - something the Department of Health says it is tackling.
    The report also predicts that by 2035, diabetes will cost the NHS £16.8bn, 17% of its entire budget.

    “Start Quote

    If this rise in diabetes is allowed to continue, it will simply be disastrous for NHS budgets”
    Baroness Barbara YoungChief executive of Diabetes UK
    There are 3.8 million people living with diabetes in the UK.
    The study looked at annual direct patient care costs for both types of diabetes, with Type 2 at £8.8bn being far higher than that of Type 1 at £1bn.
    Both Type 1 diabetes, which tends to appear in childhood, and Type 2 diabetes, often linked to diet, lead to problems controlling the amount of sugar in the blood.
    Complications occur when people with diabetes sustain high levels of glucose over a long period. This can lead to increased chances of developing disease-related complications, such as kidney failure, nerve damage, damage to the retina, stroke and cardiovascular disease.
    Budget crash
    Baroness Barbara Young, from Diabetes UK - one of the charities involved in the Impact Diabetes report - said: "The report shows that without urgent action, the already huge sums of money spent on treating diabetes will rise to unsustainable levels that threaten to bankrupt the NHS.
    "If this rise in diabetes is allowed to continue, as is happening at the moment, it will simply be disastrous for the NHS and wreck NHS budgets. I think we have a car crash coming.
    "But the most shocking part of this report is the finding that almost four-fifths of NHS diabetes spending goes on treating complications that in many cases could have been prevented.
    "That's hugely wasteful - in human life, in the quality of human life, and in NHS budgets. We need to stop this now and make sure people get the right sort of care early on in their condition."
    Baroness Young speculated that investing in better education and more frequent health checks to reduce the risk of complications could actually be less expensive than the current approach.
    Overweight personType 2 diabetes is often linked to lifestyle and diet
    She said: "We need to make sure... that we prevent people getting diabetes through good risk assessment and early diagnosis to prevent spending on avoidable complications."
    A Department of Health spokeswoman said that this was something they were doing.
    "We agree that diabetes is a very serious illness and one that has a big impact on the NHS.
    "That's why we are tackling the disease on three fronts. First, through prevention of Type 2 diabetes - encouraging people to eat well and be more active. Second, by helping people to manage their diabetes through the nine annual health care checks performed in primary care. And by better management of the condition in hospital."
    Different challenges
    Karen Addington, from Juvenile Diabetes Research Foundation (JDRF) - which was also commissioned the report - said: "It's the first time that we have been able to see the cost of the unavoidable autoimmune condition Type 1 diabetes separately.
    "This is important because the causes of Type 1 and the challenge it presents are very different to Type 2, and only medical research can lift this burden on families, the NHS and the economy."
    The report was authored by the York Health Economic Consortium and developed in partnership between Diabetes UK, JDRF and Sanofi diabetes.
    At a separate conference in Copenhagen, the cost of diabetes has also been under discussion.General Yves Leterme, from the Organisation for Economic and Co-operation and Development said: "Preventing and treating diabetes and its complications costs about 90bn euros (£73bn) annually in Europe alone.
    "With health budgets already under great pressure and national budgets severely strained, for the sake of our health and the health of our economies we must find ways to prevent and manage diabetes in a cost-effective manner."

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    NHS 'can't cope' with multi-disease patients

    GP consultationGPs often have to deal with patients who have multiple health problems

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    The health system in the UK cannot cope with the rising number of under-65s with long-term medical conditions and needs "radical change", says a study in The Lancet.
    A team of researchers analysing 1.75 million people in Scotland found that nearly a quarter had two or more chronic diseases.
    Their care was often co-ordinated poorly and inefficient, the study said.
    The team wants a more personal approach to patients with complex problems.
    At present, healthcare services, medical research and the education of medical students are dominated by a focus on individual diseases, the study authors say.
    Yet rising numbers of people are living with more than two long-term disorders, called "multimorbidity", which could include coronary heart disease, diabetes, cancer, stroke and depression.
    In general, people with multimorbidity are more likely to live in deprived areas and have a poorer quality of life. Their care is fragmented because they see a number of different specialists.

    “Start Quote

    Patients with multiple conditions need someone who can oversee all the problems of a patient.”
    Prof Graham WattGlasgow University
    Generalist approach
    The study, led by Bruce Guthrie, professor of primary care medicine at Dundee University, Professor Stewart Mercer, of Glasgow University, and Graham Watt, professor of general practice at Glasgow, says this approach should change.
    "Existing approaches need to be complemented by support for the work of generalists, providing continuity, co-ordination, and above all a personal approach for people with multimorbidity."
    Their study of nearly two million patients registered with 314 medical practices in Scotland showed that people living in the most deprived areas were particularly affected by long-term physical and mental disorders.
    These disorders were more common among poorer communities and occurred 10-to-15 years earlier than among those living in affluent areas.
    The study looked for 40 chronic conditions among the participants' data.
    Researchers found that 42% of patients had one or more conditions and 23% had two or more.
    It also found that only 9% of those with coronary heart disease, had that one disease alone.
    Similarly, only 23% of those with cancer, had only cancer and no other long-term disease.
    'Wake-up call'
    Although the prevalence of multimorbidity increased with age and was present in most people aged over 65, the actual number of people with multimorbidity was higher in those under 65, the study said.
    Graham Watt, professor of general practice at Glasgow University, said this was a problem affecting many countries, not just Scotland.

    “Start Quote

    This economic burden heightens the need to manage people with several chronic illnesses in more efficient ways.”
    Dr Chris SalisburyUniversity of Bristol
    "Any country with an ageing population is heading in this direction. All these countries are waking up to the problem.
    "The status quo isn't an option because it leads in the wrong direction."
    Prof Watt said that rather than more specialists, patients with multiple conditions "need someone who can oversee all the problems of a patient".
    "These patients need continuity, and we need ways of measuring how well care is joined-up."
    Financial burden
    In an accompanying article in The Lancet, Dr Chris Salisbury, from the School of Social and Community Medicine at the University of Bristol, said the increasing proportion of people with several co-existing medical problems had a financial impact.
    "Expenditure on health care rises almost exponentially with the number of chronic disorders that an individual has, so increasing multimorbidity generates financial pressures. This economic burden heightens the need to manage people with several chronic illnesses in more efficient ways," said Dr Salisbury.
    Dr Salisbury suggests that general practitioners in more deprived areas should have lower caseloads to account for higher levels of multiple morbidity.
    He also says that in hospitals, those with multimorbidity should be assigned to a generalist consultant who would be responsible for co-ordinating their care.
    The Scottish Government's Health Secretary, Nicola Sturgeon, said: "We are working in partnership with NHS, primary-care providers and patients, as well as the research community, so that we have effective systems in place to address the needs of people with multiple health conditions and to reduce these health inequalities."

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